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    Understanding the connect between poverty, health and healthcare

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    Population health, as described by our federal government via the Centers for Disease Control and Prevention (CDC), is a state of complete physical, mental, and social well-being and not just the absence of sickness or frailty.  The CDC has semi-quantitated these components:

    1)     Genes and Biology

    2)     Health Behaviors

    3)     Social Environment

    4)     Physical Environment

    5)     Medical Care

    Focusing on number five, medical care is the maintenance or improvement of health via the diagnosistreatment, and prevention of diseaseillnessinjury, and other physical and mental impairments in human beings by health professionals. The CDC estimates that only about 20% of a population’s health is affected by health care.  Yet, one of the reasons for the HITECH Act of 2009 was the need for physicians to report myriads of data to facilitate improvement in population health. Dr. Fisher

    It is now well documented that these reporting requirements are causing a dramatic decrease in patient-physician face time that is leading to inferior care and physician burnout.  The recent passage of the Medicare and Chip Reauthorization Act (MACRA) when in full effect, by increasing reporting demands will further compromise patient care.


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    As population health is determined by the aggregate of individual health this will negatively affect the entire population, directly in contradistinction of an original goal of the 2009 law.

    But how should we be addressing the broader issue of population health?  As behavior, social and physical environment are the greatest determinants of population health, these factors are more related to poverty than to healthcare.  There exists in this country the “war on poverty”, a serious of laws passed by Congress and signed by president Lyndon Johnson in the mid nineteen sixties. In sum it had two goals: meeting minimal material needs of the disadvantaged and decreasing their numbers over time. 

    Next: Why are so many millions of Americans in poverty?

    Ken Fisher, MD
    Kenneth A. Fisher, M.D. Nephrologist, and author, latest book, Understanding Healthcare: A Historical Perspective", available ...


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